Provider Demographics
NPI:1780769547
Name:BURNS, EDWARD R (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7045 173RD ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3449
Mailing Address - Country:US
Mailing Address - Phone:718-430-4106
Mailing Address - Fax:718-430-8714
Practice Address - Street 1:ALBERT EINSTEIN COLLEGE OF MEDICINE
Practice Address - Street 2:1300 MORRIS PRK AVE., BELFER 307
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-430-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132949207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78321Medicare UPIN